A well-known rule in the Israeli public health system is that if you care about your health, try not to go to the emergency room after 6 P.M. In fact, try not to go after 3 P.M. That's about when the specialists disappear from the public hospitals and head to their private clinics. From that time on, the hospitals are run by residents.

Senior doctors do not do night shifts. Specialists, who are in a category between residents and senior physicians, do night duty only in several critical specialties or in hospitals outside the center of the country. In general, specialists also don't do night shifts. Senior doctors are home on call at night. But it is rare for a senior doctor to be called into the hospital even in an emergency. Generally, they give the residents advice by phone.

Illustration: A hospital hall.Nir Keidar

Doctors are allowed to work in their private clinics, and they are the only professionals in the public sector who are allowed to work privately. Since the doctors, particularly the most senior ones, earn quite a lot from their private clinics, they have no incentive whatsoever to waste even one extra hour at the hospital. This explains the battle against the Finance Ministry's campaign to force doctors to clock in and out.

With or without a time clock, the battle to keep doctors at hospitals through the late afternoon is a lost cause. It is simply not worth it for them financially. That is why the hospital directors are pushing to let private medical services into state-owned hospitals.

These private medical services let patients pay to choose their own surgeons at a public hospital during the late afternoon. Allowing privatized medicine at public hospitals would give senior doctors additional income - and quite a lot of it - and would guarantee they remain at the hospitals for many more hours.

Private medicine, lite

The problem is that this arrangement was already nixed by the attorney general, and was denounced by almost every public health expert. They say it would turn public hospitals into private hospitals: Rich patients would get private doctors and preferential treatment.

A more moderate version of the private medical services are the hospital's "medical corporations." These organizations are officially subsidiaries of the hospitals, and they pay the doctors an additional salary for late afternoon surgery and work. As opposed to the private medical service model, the corporations do not take money from patients, who cannot pick their surgeon. It is the hospital paying the doctor for "overtime."

All the public hospitals have "medical corporations." They receive NIS 1.6 billion out of the state hospitals' NIS 7.6 billion budget. The treasury estimates that doctors earn an extra NIS 6,000 a month from the corporations on average. But the actual pay varies from NIS 2,000 a month for residents to NIS 8,500 for senior doctors. Looking only at large hospitals in the center of the country, senior doctors earn an average of NIS 16,000 from the corporations every month.

The Health Ministry, which until last week supported the doctors' demands, changed its tune in the face of the public's objection to introducing private health services into public hospitals. Senior Health Ministry officials now support expanding the budgets of the hospital's medical corporations as a compromise. This would enable paying senior doctors even more and would prevent them from disappearing into their private clinics, without violating the public health system's equality.

Of course, increasing the budgets for these corporations means increasing budgets for all state-owned hospitals, and requires proper supervision. But the doctors object even to clocking in and out, which says a lot about the state's ability to supervise them.

Just as a reminder, only five years ago the treasury and the Health Ministry went to war over the independence of the hospital treasurers who supervise hospital spending. Since then, the status of the treasurers has improved, and they are now called CFOs. But they still have no real independence to oversee hospital spending, certainly not by hospital subsidiaries like the medical corporations.

Strict financial oversight must be an essential part of any compromise that increases hospitals' budgets. We must also remember that increasing the corporations' budgets serves the interests of only the senior physicians, who are well paid as is. The wage problems of the residents, who work too many shifts that are too long, will not be solved.

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